AQA GCSE History Health and the People Exam Guide 2020

Medicine Through Time TimelineTask – Colour in the various dates and events based upon which area of medicine they are. Remember Some of the dates may be important in more than one category:Red = Public Health Green = Surgery Blue = Disease

450 BC Hippocrates – developed the Four Humours theory. This theory stated that there were four main elements in the body – blood, yellow bile, black bile and phlegm. Illness was caused by having too much of one of these humours inside of you. He also wrote the Hippocratic Collection, more than 60 books detailing symptoms and treatments of many diseases. Hippocrates also encouraged observation and natural treatments. His ideas were believed throughout the Middle Ages

162 AD Galen – continues the four humours theory but extends it to have the humours in opposition to each other. This meant that an illness could be treated in one of two ways, either removing the “excess” humour or by adding more to its opposite. Galen also proves the brain is important in the body (operation on the pig). Galen’s books would become the foundation of medical treatment in Europe for the next 1500 years, due to the support of the church.

980-1037

Ibn Sina (Avicenna) – wrote “The Canon” – a complete medical encyclopaedia that was used for hundreds of years after to teach European physicians.

1100s – 1200s

When Europeans went on crusades to the Holy Land, their doctors gained first-hand knowledge of Arab medicine, which was advanced by Western standards.

1347-1348

Black Death – across Europe more than 25 million people die. Two main types of plague

1. Bubonic – 50-75% chance of death. Carried by fleas on rats. Death usually within 8 days

2. Pneumonic – airborne disease. 90-95% chance of death within only 2-3 days

People had no idea how to stop the plague. People thought it was caused by various factors, i.e. the Jews, the Planets, the Gods, etc

1400 By 1400 there were over 500 hospitals in England organised by the Christian Church.

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1455 The Printing Press was invented. This allowed for the massive reproduction of books and writings without using the Church as a medium.

1517 Protestantism begins in Europe. This slowly decreases the power of the Catholic church over medicine.

1543 Andreas Vesalius – proved Galen wrong regarding the jawbone and that blood flows through the septum in the heart. He published “The Fabric of the Body” in 1543. His work encouraged other to question Galen’s theories.

1570s Ambroise Paré – developed ligatures to stop bleeding during and after surgery. This reduced the risk of infection. He also developed an ointment to use instead of cauterising wounds.

1628 William Harvey – Published his famous book “On the Motion of the Heart”. This proved that blood flows around the body, is carried away from the heart by the arteries and is returned through the veins. He proved that the heart acts as a pump re-circulating the blood and that blood does not “burn up”.

1665 The Great Plague – little improvement since 1348 – still have no idea what is causing it and still no real understanding of how to control or prevent it. However, use of quarantine (boarding up houses), burials at night, bills of mortality showed some improvements.

1668 Antony van Leeuwenhoek creates a superior microscope that magnifies up to 200 times. This is a huge improvement on the original microscope.

1721 Inoculation first used in Europe, brought over from Turkey by Lady Montague Wortley.

1796 Edward Jenner – discovered vaccinations using cowpox to treat smallpox. Jenner published his findings in 1798. In 1805 Napoleon had all his soldiers vaccinated. However, vaccination was not made compulsory in Britain until 1852. The disease was eradicated by 1980

1799 Humphrey Davy discovers the pain-killing attributes of Nitrous Oxide (Laughing Gas).

1830s Industrial Revolution. This had a dramatic effect on public health. As more families moved into town and cities, the standards of public health declined. Families often shared housing, and living and working conditions were poor. People worked 15 hour days and had very little money.

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1831 Cholera Epidemic. People infected with cholera suffered muscle cramps, diarrhoea, dehydration and a fever. The patient would most likely be killed by dehydration. Cholera returned regularly throughout the century, with major outbreaks in 1848 and 1854.

1842 Edwin Chadwick reports on the state of health of the people in cities, towns and villages to the Poor Law Commission (fore-runner to the Public Health Reforms). He highlights the differences in life-expectancy caused by living and working conditions. He proposes that simple changes could extend the lives of the working class by an average of 13 years.

1846 First successful use of Ether as an anaesthetic in surgery by William Morton. The anaesthetic had some very severe drawbacks. In particular, it irritated the lungs and was highly inflammable.

1847 James Simpson discovers Chloroform during an after dinner sampling session with friends. He struggles to get the medical world to accept the drug above Ether. Doctors were wary of how much to give patients. Only 11 weeks after its first use by Simpson, a patient died under chloroform in Newcastle. The patient was only having an in-growing toenail removed (non-life threatening). It took the backing of Queen Victoria when she was given chloroform during childbirth in 1853 for chloroform and Simpson to gain worldwide publicity.

1847 Ignaz Semmelweiss orders his students to wash their hands before surgery (but only after they had been in the morgue).

1848 First Public Health Act in Britain – It allowed local authorities to make improvements if they wanted to & if ratepayers gave them their support. It enabled local authorities to borrow money to pay for the improvements. It was largely ineffective as it was not made compulsory for Councils to enforce it. This was an element of the “Laissez-Faire” style of government.

1854 Crimean War – Florence Nightingale and Mary Seacole contribute majorly to the improvements in Hospitals. Florence Nightingale wrote two books that would have a worldwide influence, Notes on Nursing and Notes on Hospitals. She also set up nursing schools.

1854 John Snow proves the link between the cholera epidemic and the water pump in Broad Street, London. Unfortunately, he was unable to convince the government to make any substantial reforms. They still believd in Miasma.

1858 The Great Stink – the summer of 1858 was very hot and as river levels fell, the horrid smells spread across London and into the

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Houses of Parliament. This led to Joseph Bazalgette designing and building London’s sewer system.

1861 Germ Theory developed by Louis Pasteur whilst he was working on a method to keep beer and wine fresh – changed the whole understanding of how illnesses are caused.

1865 Elizabeth Garrett-Anderson – first female doctor in the UK

1865 Octavia Hill begins buying slum houses and cleaning them up to provide better housing for workers. Her influence helped to persuade the government to pas the 1875 Artisans’ Dwelling Act, giving councils the power to knock down slums on health grounds.

1867 Joseph Lister begins using Carbolic Spray during surgery to fight infection. It reduces the casualty rate of his operations from 45.7% of deaths to just 15.0 % dying. Initially he received a lot of opposition as the spray was an irritant to the surgeons’ skin. Based on Lister’s work, surgery progressed towards Aseptic surgery (where there are no germs present during surgery). From 1887, all instruments were steam-sterilised.

1875 Second Public Health Act – now made compulsory. Major requirement is that sewers must be moved away from housing and that houses must be a certain distance apart.

1880 Joseph Lister uses sterilised catgut for internal stitches.

1881 Robert Koch discovers the bacterium that causes anthrax. He establishes a new method of staining bacteria. Using Koch’s methods, the causes of many diseases were identified quickly:1880 – Typhus 1882 – Tuberculosis 1883 – Cholera1884 – Tetanus 1886 – Pneumonia 1887 – Meningitis1894 – Plague 1898 – Dysentery

1889 William Halstead introduced the wearing of sterilised rubber gloves and surgical masks to prevent further infection in surgery.

1895 X-Rays discovered by Wilhelm Röntgen. Though it is an important discovery, it is only WW1 and the treatment of soldiers that propels it into the medical spotlight.

1895 Marie Curie discovers radioactive elements radium and polonium. She will eventually win two nobel prizes for her work on X-Rays and on Radium.

1901 Karl Landsteiner discovers that there are different blood groups- this leads to the first 100% successful blood transfusions.

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1905 Paul Ehrlich discovers first “magic bullet” – Salvarsan 606 to treat Syphilis. The problem was it was based on arsenic and so could kill the patient too easily.

1906-1914

David Lloyd-George puts his Liberal Reforms into action. These were based on investigations by Seebohm Rowntree and Charles Booth that highlighted the state of poverty and its impact upon people’s health.

1911 National Health Insurance introduced in Britain – this entitled people to medical treatment and sick pay.

1914-1918

World War One – This was a huge turning point in medicine as it created many patients requiring skin grafts, treatment for burns, gas inhalation, etc.

1916 Sodium citrate was added to blood to prevent it clotting for use in the war. This meant that blood could now be stored for several weeks before being used.

1928 Alexander Fleming – discovers Penicillin. The mould had grown on a petri dish that was accidentally left out. Fleming writes articles about the properties of Penicillin, but was unable to properly develop the mould into a drug.

1930s Archie McIndoe begins using skin grafts to reconstruct faces and hands in WW2. He carried out more than 4000 operations on burns cases. This results in the Guinea Pig Club being set up to help all those who he had treated.

1932 Gerhardt Domagk discovers Prontosil (the second magic bullet). Slight problem is that it turns the patient red.

1937-45 Florey & Chain work on producing penicillin as a drug. Their success will make the drug the second most funded project by the USA in WW2. They fund it to the tune of $80 million and every soldier landing on D-Day in 1944 has Penicillin as part of his medical kit. (Over 2.3 million doses)

1942 William Beveridge publishes the Beveridge Report. The report was the blueprint for the NHS and brought in the process of everyone working paying National Insurance.

1946 National Health Service Act – provides for a free and comprehensive health service. Aneurin Bevan convinces 90% of the private doctors to enrol.

1948 World Health Organisation set up by the United Nations. Its greatest success has been the wiping out in Europe of Smallpox. By 1980, this had been wiped out across the world.

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1948 First day of the NHS. Hospitals were nationalised, health centres were set up and doctors were more evenly distributed around the country. This was mostly due to the work of Aneurin Bevan whose speeches in favour of the NHS won support. He compromised with private doctors and managed to persuade them to work in the NHS.However, the popularity and costs of the NHS would rapidly spiral out of control. The £2 million put aside to pay for free spectacles over the first nine months of the NHS went in six weeks. The government had estimated that the NHS would cost £140 million a year by 1950. In fact, by 1950 the NHS was costing £358 million.

1950 The first open-heart surgery is performed to repair a 'hole' in a baby's heart, using hypothermia.  

1952 Charges introduced in NHS – 1 shilling for a prescription.

1953 Francis Crick and James Watson discover the structure of DNA. They proved that it was present in every human cell and showed how it passed on information from parents to children.

1961 Contraceptive pill introduced

1967 Christian Barnard (South African) performed the first heart transplant - the patient lived for 18 days

1978 First test tube baby

1986 The Human Genome Project began to identify the exact purpose of each of the genes in the human body, compiling a complete map of human DNA.

1990s Increasing use of keyhole surgery, using endoscopes and ultrasound scanning, allowed minimally invasive surgery.

1994 National Organ Donor register created

1998 NHS Direct begins – this is a 24 hour telephone advice service staffed by nurses.

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Medicine Through Time Revision NotesTo answer questions on medicine through time you need to know the dates of the different time periods and some details about their way of life. Remember, the history of medicine is divided into three themes – Disease, Surgery and Public Health:

The Romans: 500BC - 500AD

GALEN developed Hippocrates theory of the Four Humours to now include the use of opposites. Any imbalance in the body caused by a humour expanding and causing illness could be treated with the opposite of the illness to put the humours back in balance. E.g. for a cold you took a hot bath.

Galen also wrote over 350 medical books. His books would still be the foundation of medical knowledge 1400 years later. His books remained influential because his ideas fitted in with the ideas of the Christian Chrurch, which would control education in the Middle Ages. He believed that the body had been created by one god, who had made the body fit perfectly together. He also believed like Hippocrates in observation

Galen worked with gladiators in Pergamum so gained a good knowledge of our anatomy. His most famous experiment showed the impact of the brain. He cut the vocal chords of a pig. This clearly demonstrated how the nervous system takes messages from the brain to the muscles.

Medieval Western Europe: 500 – 1500 AD

After the collapse of the Roman Empire much of Western Europe no longer had strong government. They were not organised and didn’t see the importance of hygiene. There were many wars and a break down in communication between countries.

The Catholic Church was very powerful and there was return to the belief that God caused and cured disease. Education was often restricted to Monks and natural ideas were not encouraged as they went against God and the Church. Most knowledge from the Greeks and Romans was lost. Some churches and monasteries collected, copied and wrote books about religion, but also about herbs and medicine. They were handwritten, rather than printed, so it was not easy to spread knowledge quickly.

The Black Death in 1347-1350 killed more than 25 million people across Europe. There were three types of Plague:

1. Bubonic Plague – this was the most common type of plague. Approximately 90% of plague victims suffered from this type. It was carried on the fleas on rats. About half of all victims died within 7 days of contracting the disease.

2. Pneumonic Plague – this was the most deadly type of plague. It only affected about 5% of the population but nearly 98% of victims died. It was an airborne disease and people died from drowning in their own blood.

Cures for disease were based around the supernatural. E.g. pray, take a blessed potion, go on a pilgrimage, and flagellate ( whip ) yourself as a punishment from God. People would pay small fortunes for things like an abracadabra pendant that was supposed to prevent you getting the Plague.

There were some natural cures, e.g. blood letting, testing urine and the use of leeches. Some doctors also used astronomy and astrology.

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Public health conditions grew worse. Rivers were used as dumping grounds for sewage and other waste and also as sources of drinking water. As towns grew in size, the problem became worse. Town governments passed laws against dumping sewage and other waste but could not suggest ways of dealing with the problems.

Military surgeons carried out simple operations on wounded soldiers. Wine and hot cauterising irons were used (these ideas were taken from the Arabs). Wine was used as a cleaning agent (antiseptic). Most surgery was simple and external, such as removing cataracts. Most surgery was carried out by barber-surgeons rather than trained doctors. There was also opposition to surgery, surgeons were called thieves, man killers and cheats. Most surgery was either controlled or limited by the Christian Church. It was considered to be a religious crime (heresy) to question the work of Galen. You could be killed for it!

Medieval Islamic World: 500 – 1500 AD

The Prophet Muhammad said: "Make use of medical treatment, for Allah has not made a disease without appointing a remedy for it, with the exception of one disease, namely old age." Medicine was readily accepted in Islam, in direct comparison to Christianity where new ideas were often forbidden.

It was healthier to live in Arab-occupied Europe than in the Christian-ruled areas because the Arabs believed in cleanliness.

AVICENNA (Ibn Sina) wrote the Canon of Medicine, which contained all known treatments of disease. This encyclopedia was translated into Latin. It became the textbook for medical education in the schools of Europe from the 12th-17th century.

RHAZES (Al –Razi) noticed the difference between measles and smallpox. He was also an expert surgeon and was the first to use opium for anesthesia. He also emphasized the importance of psychological factors on health (such as having a positive attitude, avoiding stress, etc.).

They were very religious and followed the teachings of Islam. This told them to care for the sick and as a result they built many hospitals. Knowledge from the Romans and Greeks was not lost, doctors studied their books and kept medicine alive. The Crusades (religious wars with the west) meant that many Ancient ideas and new developments were kept mainly within the Islamic world.

Greek books were translated into Arabic, some Islamic doctors wrote their own books on surgery. Operations were carried out; even the removal of bladder stones, they stopped the flow of blood by using a cauterising iron. Improvement in surgery was limited due to dissection being forbidden due to religious reasons.

The Renaissance: 1500 – 1750

The word Renaissance means rebirth. Roman and Greek ideas were studied again and improvements were made. The Reformation also occurred, this is when England became Protestant. As a result the Catholic Church had less control over people’s lives and dissection was allowed. It also led to people challenging old ideas and asking questions to find out more.

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The 1665 Plague epidemic was the last major one in Britain. During the Great Plague, when bubonic plague came back to London, there was more of an understanding that poor hygiene caused poor health. The Lord Mayor ordered the streets to be cleaned and although it made London a healthier place, it did little to stop the Great Plague spreading. Almost 70,000 people died from Plague in London alone in 1665.

Inventions such as the printing press helped to spread new ideas across Europe. There was also an improvement in art due to careful observation – artists such as LEORNARDO DA VINCI made detailed anatomical drawings. These helped to improve knowledge about the body as they were printed in books. The microscope and telescope were invented and technology inspired men to understand the human body more. King Charles II was very interested in science and set up the Royal Society in 1661, experimentation and new approaches were encouraged.

However, there was hardly any change; treatments were still based on a mixture of supernatural and the four humours. It was a rebirth of old ideas – ideas from the Greeks and Romans were studied again and some improvements were made, but much of these ideas were wrong in essence. A good example to show that treatments had not progressed is to look at the treatment and subsequent death of King Charles II in 1685. He was treated with laxatives, bloodletting and vomiting.

Most progress was made in other areas of medicine, especially anatomy: ANDREAS VESALIUS dissected human bodies to help him understand how they worked and commissioned life-like drawings. Galen had dissected animals, but this had led to mistakes.

Vesalius found that Galen had been wrong about the human jaw. Galen wrote that it was made of two bones, whereas Vesalius found only one. He also found that the septum in the heart was too thick and had no holes for the blood to flow through, as Galen had said.

Vesalius published his book “The Fabric of the Human Body”. This completely mapped the bones, organs, muscles, etc of the human body.

AMBROISE PARE developed surgery by challenging old ideas and methods. Pare was forced to use a lotion of oil of roses, egg yolks and turpentine

when he ran out of oil to treat gunshot wounds on the battlefield. This chance event worked, it caused less pain and healed wounds more quickly. Silk threads (ligatures) were used by Pare to tie up arteries rather than stop bleeding by using a cauterising iron. However, ligatures for amputations were not really practical until the invention of the tourniquet two centuries later. Also, without antiseptics or knowledge of germs, the silk thread used as ligatures easily carried bacteria into the body and caused infection.

WILLIAM HARVEY demonstrated the function of the heart and how blood flows around the body through veins and arteries. Harvey’s discoveries concluded that:

o the heart works like a pumpo blood flows in one direction only around the bodyo one-way valves stop the blood going the wrong wayo blood is re-circulated and not replaced

Disease 1750 - modern day

The 18th Century: EDWARD JENNER discovered the cure for Small Pox by chance and the first real vaccination against disease was introduced. In 1796, he carried out his now famous experiment on eight-year-old James Phipps. Jenner inserted pus taken from a cowpox pustule and inserted it into an incision on the boy's arm. He noticed that milkmaids who suffered the mild disease of cowpox never contracted smallpox, one of the greatest killers of the period, particularly among children. Jenner subsequently proved that having been inoculated with cowpox Phipps was immune to smallpox. Jenner was widely ridiculed. Critics, especially the clergy, claimed it was repulsive and ungodly to inoculate someone with material from a diseased animal.

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A satirical cartoon of 1802 showed people who had been vaccinated sprouting cow's heads. Vaccination saved lives and the idea of injecting people with a disease to prevent them catching the full disease is the foundation of modern vaccinations.

The 19th Century: During this period scientists worked hard to find out more about what caused disease. This was due to the growing rise in epidemics, e.g. cholera. The turning point was in 1861 when LOUIS PASTEUR proved his germ theory of disease - germs in the air caused decay, (It was found by chance whilst he was working on why some wine went bad during production). Before Pasteur, the accepted theory of the cause of disease was called Spontaneous Generation – Germs caused disease and came from anything decaying. Pasteur proved that bacteria could be

removed by boiling and then cooling the liquid. This process is now called pasteurisation. Pasteur extended this theory to explain the causes of many diseases - including anthrax, cholera, TB and smallpox. He also found vaccinations for these. He is best known for his work on the development of vaccines for chicken cholera in 1881 and rabies in 1885.

ROBERT KOCH took Pasteur’s work and developed it to identify specific germs that caused disease in humans. Koch and Pasteur were from different countries and were rivals; this spurred them on to further discoveries and encouraged governments to fund their research. Koch and his team developed ways of staining bacteria to improve the bacteria’s visibility under the microscope. From this, he found the germs of two feared diseases – anthrax and Tuberculosis in 1882. He had developed research techniques that others could use throughout the world. The 20th Century: After 1900, chemical drugs that cured disease were discovered. In 1909 PAUL EHRLICH discovered the first magic bullet – a compound of arsenic, which killed the syphilis germ, called Salvarsan 606. This, however, was also very dangerous and unstable. In 1932 the second magic bullet was developed by GERHARDT DOMAGK. He used a red dye called Prontosil in a last-ditch effort to cure his daughter who was suffering from blood poisoning. Although Prontosil was successful, it did have a rather odd side effect – it turned his daughter red!

Penicillin was discovered by accident by ALEXANDER FLEMING in 1928. He had left his Petri dishes unwashed over a two-week holiday and then noticed that a mould growing on the Petri dish was killing the streptococci bacteria on the petri dish. However, he was unable to convert this into a format that could be used in animal trials.

HOWARD FLOREY & ERNST CHAIN found Fleming’s paper on Penicillin in an old journal and sought to take his work further between 1939 and 1945. During the Second World War, Florey and Chain turned their department at Oxford into a penicillin factory. Trials of penicillin were held at the Radcliffe Infirmary in Oxford from

1941 and were successful. However, the British scientists struggled to produce the quantities of penicillin needed to sustain their clinical trials on humans and turned to the United States for help. The US government funded Penicillin to the tune of $80 million and it became the second most funded project in WW2. By 1944, mass production would enable 2.3 million units of Penicillin to be available to the soldiers that landed on D-Day. In 1945, Fleming, Florey and Chain were awarded the Nobel Prize for Physiology or Medicine.

In 1953 FRANCIS CRICK and JAMES WATSON discovered the structure of human DNA and how it is passed on from parents to children. In the 1990s the Human Genome Project, a worldwide project, began working out

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exactly how each part of human DNA affects the human body. Understanding DNA opens up many possibilities, such as…

Gene therapy – using genes from healthy people to cure the sick

Customised drugs – creating drugs to cure one person’s particular health problem

Genetic engineering – allowing parents to ‘design’ their children, including gender and even hair colour

Genetic screening – identifying the illnesses people could suffer from and being able to prevent them

The WORLD HEALTH ORGANISATION (WHO) was set up in 1948 by the United Nations. The WHO’s greatest success has been the wiping out of smallpox. They began their campaign in 1967 and by 1980 was able to declare that smallpox had been wiped out across the globe. In 1987, the WHO launched a campaign to fight HIV/AIDS, which destroys the body’s immune system. Two-thirds of HIV infections are in sub-Saharan Africa. In Zimbabwe, the adult rate of HIV infection is almost 25% (compared to 0.2% in the United Kingdom)

However, there have also been problems with some drugs: Between 1959 and 1962 a new drug called Thalidomide was given to women to

reduce morning sickness. It had not been properly tested and this led to children being born with deformed limbs.

‘Superbugs’ such as MRSA have developed an ability to resist science’s efforts to kill them, either with antiseptics or antibiotics. These have particularly been a problem in NHS hospitals.

CJD is a rare and fatal brain disease that appeared in 1996. The most likely explanation for its occurrence was from people eating beef from cattle that had been infected with a disease known as BSE.

Surgery 1750 – modern day.

19th Century: Much surgery was carried out but there were three main problems – patients died because of pain, infection and bleeding.

Pain was overcome by the discovery of anaesthetics. Nitrous Oxide (Laughing gas) was discovered in 1799 by HUMPHREY DAVY. Although he published a paper on its properties, he failed to notice its medical benefits as an anaesthetic. HORACE WELLS first used laughing gas during and operation in 1844 but failed to get it recognised. His former colleague WILLIAM MORTON took his idea further with the development of Ether as a useable anaesthetic. Many surgeons at that time used Ether, despite it being very dangerous and the fact that it caused many respiratory problems. In 1847 JAMES SIMPSON discovered the use of Chloroform. Surgeons then became more confident and performed more complex operations, but patients still died of infection. Many people also opposed anaesthetics, they were scared as some patients were allergic and died, also it was against their religious beliefs, especially during child birth.

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In 1847, IGNAZ SEMMELWEIS noticed that the death rate of mothers was higher in the wards where they were treated by medical students who had come straight from the dissecting room. He decided that students who had just been dissecting mothers who had died from the disease transferred the disease to healthy mothers. Semmelweis made all the medical students wash their hands between patients, despite the disagreement of his superior, who did not believe hand-washing had any effect. The mortality rate of mothers dropped from about 18% to 1%. JOSEPH LISTER overcame the problem of infection in 1867 by using carbolic acid in a spray to kill infection in wounds. Originally this was unpopular due to the mess that carbolic spray created and the time that it took, however once the death rate decreased and Pasteur’s germ theory was accepted it became widely used.

During the Crimean War in 1854, two key individuals also helped progress in surgery. FLORENCE NIGHTINGALE concentrated her efforts on cleaning the army hospital at Scutari. She reduced the death rate of wounded soldiers from 40 per cent to only 2 per cent. She became a national heroine and on returning home, she set up her first nursing school. In 1859, she wrote her book ‘Notes on Nursing’, and in 1863 ‘Notes on Hospitals’. Both books were very influential all over the world, providing the basis for training nurses and hospital design. MARY SEACOLE paid her own way so that she could help out in the Crimean War. She set up her ‘British Hotel’ providing food and drinks to the soldiers. She also treated soldiers on the battlefield. After the war, as she returned to Britain, her skills and experience was largely ignored. It is only recently that her work has received the acclaim it deserved.

The end of the 19th century saw the start of the development of aseptic surgery. Koch’s discoveries led to surgical utensils being steam-sterilised and in 1889 WILLIAM HALSTEAD introduced the wearing of sterilised rubber gloves and surgical masks to prevent further infection in surgery. The problem of bloodloss, however, would not be solved until the 20th century.

20th Century: The discovery of blood groups by KARL LANDSTEINER in 1901 meant that transfusions were now possible. Previously, patients that had used transfusions would randomly die on the operating table. This was especially important during the World Wars. In the 1910s it was discovered that by adding anticoagulant and refrigerating the blood it was possible to store it for some days, thus opening the way for blood banks. During WW2 blood banks were set up and these have continued ever since.

WILHELM RÖNTGEN discovered X-rays in 1895 and these became very important in WW1. Surgeons needed to locate bullets and shrapnel lodged

deep within wounded men and x-rays were the answer. Radiation therapy followed on from Röntgen’s discovery of x-rays through the work of MARIE CURIE. She and her husband discovered radium, which has been used ever since to diagnose and treat cancers.

In the 1940s, ARCHIE MCINDOE learned how to rebuild surgically the faces of airmen (the 'Guinea Pig Club') who had suffered burns in the war. He carried out over 4000 operations on burns cases and pioneered the first plastic

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surgery. In 2002, nearly 7 million cosmetic surgical procedures were performed in the US alone. The first organ transplant surgery was done in 1967 by CHRISTIAN BARNARD who transplanted a heart. The patient died after 18 days, but much had been learned and it was still considered to be a resounding success.

The later 20th century saw the increasing use of keyhole surgery, endoscopes, micro-surgery and ultrasound scanning to minimise invasive surgery. It is now possible to make plastic hearts and pace makers.

Public Health 1750 – modern day

Industrial Revolution: As more and more people moved into the towns to work, houses were built as close together as possible. Many of them were damp and overcrowded. There were no planning and building regulations as the government believed in laissez-faire. There was little understanding of the true causes of disease. Many towns had no sewers and everywhere there were stinking toilets and piles of filth which seeped into rivers from which drinking water was taken. All this encouraged disease, especially among the poor. On top of this, working conditions in the factories were appalling. Workers had long hours, short breaks and could easily fall ill through the work itself, such as swallowing cotton fibres or textile dust.

Tuberculosis, Typhoid (spread by water and food) and Smallpox attacked people already weakened by overcrowding, poor diet and exhaustion. The average life expectancy for a poor person born in Manchester in 1830 was only 19. In 1831 a new disease hit Britain and forced the government to take action - Cholera. It terrified people because it could kill them in a matter of hours. It struck people suddenly and at random, with victims losing 1/2 litre of fluid an hour through diarrhoea and vomiting.

In the 1830s the government asked EDWIN CHADWICK to look into the links between poverty and bad health. His report,

‘The Sanitary Conditions of the Labouring Population of Great Britain', proved the links between poor living conditions and bad health.

Average age of death in 1842:

. Manchester Leeds Liverpool RutlandGentlemen and professional people 38 44 35 52 Tradesmen 20 27 26 41 Labourers 17 19 15 39

Chadwick’s report contained many shocking details of what many people had to face every day. He recommended better quality housing, good sewage systems and fresh water. The cost of this, however, would have to be met by the ratepayers, who could afford to live in much better conditions, and so was fiercely opposed by many of them. From 1837 all births, deaths and marriages had to be registered. WILLIAM FARR used this information to build an accurate picture of where death rates were highest and what people died of. His work, coupled with Chadwick’s report put more pressure on towns and the government to do something about public health.

The result was the Public Health Act of 1848. The 1848 law allowed towns to set up a Local Board of Health but these boards could not force towns to take any action. The Act was not compulsory and only a few local authorities took action. By 1872 only 50 councils in Britain had appointed Medical Officers of Health. The taxpayers in particular did not support this Act:

“The Board of Health has fallen. We prefer to take our chance with cholera than be bullied into health” – The Times, August 1854

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In 1854, there was a major cholera outbreak in London. It had devastating outcomes with over 500 fatalities. Nearly all families lost at least one member (regardless of socioeconomic class). By talking to local residents, JOHN SNOW identified the source of the outbreak as the public water pump on Broad Street. John Snow had now proved the link between cholera and poor water supply. However, until Pasteur’s Germ Theory will be published, many scientists still clung to the ‘bad air’ theory.

How John Snow proved that the Broad Street Pump was causing the deaths from Cholera.

After Snow had collected his evidence he was allowed to remove the handle of the water pump in Broad Street. It was later discovered that a leaking cess pit containing sewage was only 3ft away from the well and was contaminating the water.

Public Health conditions worsened despite Snow’s work. The summer of 1858 was very hot and as river levels fell, and horrid smells spread across London and into the Houses of Parliament. This was referred to as ‘The Great Stink’. This led to JOSEPH BAZALGETTE designing and building London’s sewer system.

In 1867 working men finally got the right to vote. This now put pressure on the government to do something about public health as it could now affect their popularity and votes. The result was the 1875 Public Health Act. This Act was compulsory rather than optional and so had a much greater impact. All towns were now forced to provide clean water, proper drainage and sewage, and the appointment of a Medical Officer of Health. However, even by the end of the 19 th century, public health had not been revolutionised. Infant mortality was actually higher than it was at the end of the 18th century.

In 1889, 46 years after Chadwick’s report, a wealthy businessman called CHARLES BOOTH published his findings of living conditions in the East End of London which still highlighted poor living conditions and ill health. He discovered that 35% of people in the East End were living in poverty – far more than had been claimed. His work was then couple with the work of SEEBOHM ROWNTREE who also investigated living conditions and poverty in York and published his report in 1901. Rowntree had proven that more than a quarter of people in York lived in poverty. Together, their work put huge pressure on the governments to do something about public health once and for all.

The 20th Century: Once the link between conditions and disease had been proven by Pasteur’s germ theory, governments began to take responsibility for housing, hospitals, food quality, pollution, child care etc. It was the beginning of the welfare state. The Liberal Government under the direction of DAVID LLOYD GEORGE that took office in 1906 was determined to improve public health conditions. They introduced a number of important reforms:

The Liberal Reforms: 1902 - Midwives had to be properly trained and registered.1906 - Free school meals for poor school children.1907 – All births had to be registered and a health visitor visited each mother to make sure she knew how to protect her baby’s health.1908 - Government paid Old Age Pensions.

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1909 - Back to back houses banned.1911 - National Health Insurance Act—working men received sickness pay and could see a doctor.1912 – Clinics held in schools to give children free medical treatment.

After promising ‘Homes fit for Heroes’ for returning soldiers from WW1, Lloyd George created a new Housing Act in 1919 that ensured that councils provided good home for working people to rent. A quarter of a million new homes were built. In the 1930s, many old, unhealthy slum houses were cleared and another 700,000 new houses were built. However, the economic depression of the 1930s meant unemployment rose to over 3 million. This meant that the National Health Insurance Act was failing.

Why was 1900—1939 a time of progress in public health? Liberal Government (1906—1914) decided it was time for

the government to tackle social evils present in society. The laissez-faire attitude of the 19th century became less

fashionable as attitudes towards causes of poverty changed.

New research by Booth & Rowntree highlighted real causes of poverty. (Sickness, low wages, old age & unemployment.)

War – The nation was shocked to discover 40% of the soldiers fighting in the Boer war suffered from malnutrition.

World War Two had a big impact on people’s attitudes to public health. It was a ‘Total War’, meaning that all parts of society were vital. People were fighting on the home front as well as on the front line, and so the feeling grew that everyone should have access to good health care, not just the wealthy. This led the government to commission up the Beveridge Report in 1942. SIR WILLIAM BEVERIDGE recommended a free national health service that would be paid for from taxes. Doctors, nurses and other medical workers would become government employees instead of charging the sick privately for treatment. The Beveridge Report was greeted with enthusiasm by many people and over 600,000 copied were sold. However, despite the general enthusiasm, there was powerful opposition, mainly from the doctors themselves.

Why was the NHS introduced in 1948? Impact of WW2. The government was aware that medical services had to be adequate to

cope with casualties and so increased its involvement. The Beveridge Report, 1942 was a best seller, indicating that the public supported the

idea that the state had a responsibility to care for its people. The election of the Labour Party in 1945. The Conservatives felt that a ‘Welfare State’

would be too costly whereas the Labour Party were prepared to push ahead with social reform.

The work of ANEURIN BEVAN – his speeches in parliament won huge support and he also persuaded the doctors to work for the NHS.

1948 – The start of the National Health Service. Treatment is based on the need and not the ability to pay. All people in Britain were provided with medical treatment completely free of charge. Since then however more and more charges have been introduced, this is because new drugs are expensive, average life expectancy has increased and an increased burden is being placed on the service.

The Key Service of the NHS:

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The effect of the National Health Service on people’s health was dramatic. For the first time ever, everyone had the right to free health care. Before the NHS many could not afford to visit the doctor, let alone buy medicines or have regular treatment. By the end of the 20th century, however, the NHS was facing one financial crisis after another. Prescription charges, introduced in the 1950s, rose steeply. Charges were introduced for dental treatment and eye tests. Unable to pay for the necessary staff, many beds remained empty while the waiting lists grew longer.

Why has the NHS ended up costing so much?The provision of free health care for all resulted in people being healthier and living much longer. The NHS had many more people to look after, many of them at an age where they needed increasing amounts of treatment, such as cataract operations or hip replacements. Developments in science and technology resulted in a far greater range of treatments being offered, many of which were extremely complex and expensive. Organ transplants, ultrasound scans, open heart surgery and laser treatments are just a few examples of everyday services offered today.

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The Big Medicine Quiz – Get someone to test you!1. What was the basis of the Four Humours theory?

2. In which year was the second Great Plague in England?

3. What did Galen do that was so important?

4. In which year did Pasteur publish his “germ theory”?

5. Give 2 examples of famous Islamic doctors.

6. Which surgeon developed the idea of using carbolic spray to prevent infection?

7. In which year did Fleming discover penicillin?

8. In which year was the NHS introduced?

9. In which year was the First Public Health Act published?

10. How did the creation of the Printing Press help medical progress?

11. In which year was the Second Public Health Act published?

12. Which Hungarian doctor first told his pupils to wash their hands before surgery?

13. What did Vesalius discover?

14. Which word means the prevention of infection in surgery?

15. What was the Hippocratic Oath?

16. What did William Harvey discover?28

17. Why is Queen Victoria important in the history of Anaesthesia?

18. In which war was penicillin first used?

19. In which year was the cause of cholera discovered?

20. What were the three main problems in surgery?

21. Who discovered that the problem of cholera was centred on the water pump in Broad Street, London?

22. When did Chadwick write his report about how to improve public health conditions?

23. Who discovered X-Rays?

24. What did Archie McIndoe do?

25. Name three things that people thought caused the Black Death.

26. What do we call the “bad smells” that people thought made you ill?

27. Why is Florence Nightingale famous?

28. What did William Halstead do?

29. Who discovered laughing gas and when?

30. In which year were blood groups discovered?

31. Why is Christian Barnard an important person?

32. Why was there so much opposition to Jenner’s vaccinations?

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33. What did Seebohm Rowntree and Charles Booth do to improve public health?

34. What were the Liberal reforms?

35. Which war had the bigger impact on medicine, WW1 or WW2? Explain your answer.

Exam Questions: 1. How useful is Source A –

2. Explain the significance –

3. Compare –

4. Factors – e.g. Has science and technology been the main factor in understanding the causes of disease in Britain?Has warfare been the main factor in improving surgery and knowledge of anatomy?Has religion been the main factor in the progress of medicine? Has government been the main factor affecting the development of public health?

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